There was no difference in the rates of neutropenic fevers or infections, and the overall rates of these events was low

Pain response was improved for D q3wk (p=0.01) but not D qwk (p=0.07)

FACT-P (pain) QOL scale was improved for both D q3wk (p=0.009) and for D qwk (p=0.005)

Author's Conclusions

The use of docetaxel in HRPC is safe and increases survival by 24%

Docetaxel improves PSA response and improves pain scores

Prostate cancer should now be considered a chemotherapy sensitive disease

Docetaxel with prednisone is the new standard of care in treatment of HRPC

Future studies should address the role of docetaxel in earlier stage prostate cancer

Clinical/Scientific Implications

This study in conjunction with SWOG 9916 (which was also present during this plenary session) both show a survival benefit with the use of docetaxel in the setting of HRPC. This is the first time that an overall survival benefit has been seen with the addition of chemotherapy in these patients. It should be noted that although the survival benefit was statistically significant in both studies, the overall gain was small. The use of docetaxel q3wk resulted in an increase in median survival of only 2 months. When compared to SWOG 9916, both studies showed similar rates of PSA response, objective response, median survival, and hazard ratio for death compared to MTX + P. With these two studies, it appears clear that docetaxel is an active agent with disease.

The optimal scheduling of docetaxel is still unclear. Although the D q3wk arm achieved a higher median survival, it was also associated with higher rates of grade 3/4 neutropenia. The study was not powered to directly compare these two arms; therefore, a definitive conclusion regarding docetaxel scheduling cannot be drawn. What is clear is that although docetaxel is active, its overall benefit is modest. Future studies utilizing docetaxel with other agents should be studied in an attempt to increase the overall benefit seen with chemotherapy. More importantly, these two studies (TAX-327 and SWOG 9916) may help change to prevalent mentality that prostate cancer is a chemotherapy resistant disease.